Amputation

Is Above or Below the Knee Amputation Better?

11/07/2006

Question:

Which is better, above or below the knee amputation?

Answer:

Amputation below the knee is far preferable to amputation through or above the knee. This is true even for a person who wouldn't be doing much - or any - walking after amputation, since having an intact knee joint significantly improves mobility in the bed.

An above-knee amputee must expend considerably greater effort to walk with a prosthesis compared to a below-knee amputee walking with a prosthesis. And, despite the considerable advances which have been made in prosthetic componentry for above-knee amputees - particularly with the availability of microprocessor-controlled knee units - there really is no substitute for the structure and function of an intact knee joint.

Exceptions to the usual preference to keep the knee joint intact would include:

if a below-knee amputation would result in too short of a residual limb to allow proper use of a below-knee prosthesis;

if scarring or hypersensitivity of a below-knee residual limb would make use of a below-knee prosthesis unlikely;

if there is severe arthritis or internal derangement of the knee which would be expected to result in excessive pain with weight-bearing on that knee; or

if there is a significant knee flexion contracture - meaning the knee is unable to be straightened past a certain point - such that the advantages of a below-knee prosthetic socket couldn't be utilized.

The specifics of each patient's unique situation should be discussed with each patient by his/her physicians, to determine what is best for them.

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